1. Field of the Invention
This invention relates to new and useful improvements in laser-surgical instruments and more particularly to an instrument having provision for selective application of vacuum to the surgical site.
2. Brief Description of the Prior Art
Laser-surgical instruments having come into use in recent years as an alternative to electrosurgical instruments which have been in use for about 50 years.
Hyams U.S. Pat. No. 2,102,270 discloses an electrosurgical instrument for female sterilization procedures having an auxiliary tube surrounding the electric blade for introduction of a liquid for radiologically monitoring the operation.
Bierman U.S. Pat. No. 2,275,167 discloses an electrosurgical instrument for removal of tissue by electric current and having means for applying vacuum for drawing in and holding the tissue being cut.
August U.S. Pat. No. 2,808,833 discloses an electro-cauterizing instrument with a tube for supplying an inert gas to blanket the surgical site.
Seiger U.S. Pat. No. 2,888,928 discloses an electro-cauterizing instrument with a tube for withdrawing blood and smoke from the surgical site by vacuum.
Morrison U.S. Pat. No. 3,828,780 discloses an electro-cauterizing instrument with a tube for withdrawing blood and smoke from the surgical site by vacuum and having a side vent opening.
Roberts U.S. Pat. No. 3,906,955 discloses an electro-cauterizing instrument with a tube for withdrawing blood and smoke from the surgical site by vacuum and constructed for easy replacement of the blade.
Durden U.S. Pat. No. 3,974,833 discloses an electro-cauterizing instrument with a tube for withdrawing blood and smoke from the surgical site by vacuum and having a side vent opening arranged for selective opening and closing to control application of vacuum.
Walker U.S. Pat. No. 4,562,838 discloses an electro-cauterizing instrument with a tube for supplying fluid to the surgical site for removing blood and smoke and having a light transmitting cable for illuminating the surgical site.
The prior art as exemplified by these patents and by the instruments now in use in surgery have certain similarities and certain deficiencies in design. All instruments of this type have an electrode for high frequency electro-coagulation. Likewise, most instruments of this type have a tube associated with the blade to either supply a liquid to the surgical site or to aspirate blood and fluid or air (smoke) away from the site. Roberts U.S. Pat. No. 3,906,955 and Walker U.S. Pat. No. 4,562,838 have superficial similarities to this invention and in certain applications work similarly. However these instruments are not as versatile and do not work well in all types of operating conditions. Roberts U.S. Pat. No. 3,906,955 discloses an electro-cauterizing instrument with a tube for withdrawing blood and smoke from the surgical site by vacuum but has a design which provides an inadequate air circulation through the tip for removal of smoke and fluids. Walker U.S. Pat. No. 4,562,838 discloses an electro-cauterizing instrument with a tube for supplying fluid to the surgical site for removing blood and smoke and having a light transmitting cable for illuminating the surgical site, but has an inefficient design of the air flow passages for removal of blood and smoke from the surgical site.
My co-pending application discloses an electrosurgical instrument comprising a hollow tubular member open at one end for connection by a hollow tubing to a source of vacuum and a side opening adjacent to the open end. The opposite end of the tubular member includes a tapered hollow nose portion which may be integral with the tubular member or a separate piece. An electrocauterizing blade is secured in and has one end extending outward from the end of the nose portion and the other end positioned inside the tubular member. Electric heating is provided for the electro-cauterizing blade through an electric lead extending through the tubular member and through the side opening for connection to a power source. The electric heating is usually by application of high frequency current but may be provided by resistance heating. The nose portion has a plurality of openings adjacent to the tapered surface thereof for withdrawing smoke from a surgical area being cut and cauterized by means of vacuum connected to the end of the tubular member. Selectively control of the application of vacuum through the nose portion openings is provided by a tubular sleeve member supported for longitudinal movement on the nose portion to an extended position for selectively covering and uncovering the nose portion openings.
Laser-surgical instruments having come into use in recent years as an alternative to electrosurgical instruments which have been in use for about 50 years. One example of a laser-surgical instrument in current use is the SLT Model CL60 Laser manufactured and sold by Surgical Laser Technologies, Inc., Malvern, Pa. Details of this equipment are available in manufacturer's literature and in the submission for approval by the U.S.F.D.A. This laser-surgical equipment has a provision for introducing a purge gas to keep smoke away from the focusing lens, but has no provision for evacuating smoke from the site or area of surgery.
SUMMARY OF THE INVENTION
One of the objects of this invention is to provide a new and improved laser-surgical instrument having an evacuation system of more efficient design for removal of blood and smoke from the surgical site.
Another object of the invention is to provide a new and improved laser-surgical instrument having an evacuation system permitting selective application of vacuum during surgery.
Another object of the invention is to provide a new and improved laser-surgical instrument having an arrangement for enclosing the surgical site to force circulation of air through that region by application of vacuum.
Still another object of the invention is to provide a new and improved laser-surgical instrument having a hood or sleeve which is extensible to cause circulation of air through the surgical site and out through discharge openings by application of vacuum to the opposite end of the instrument.
Still another object of the invention is to provide a new and improved laser-surgical instrument having a removable and disposable hood or sleeve for causing circulation of air through the surgical site and out through discharge openings by application of vacuum to the opposite end of the instrument.
Still another object of the invention is to provide a new and improved laser-surgical instrument having a removable and disposable hood or sleeve which is extensible for causing circulation of air through the surgical site and out through discharge openings by application of vacuum to the opposite end of the instrument.
Other objects of the invention will become apparent from time to time throughout the specification and claims as hereinafter related.
The foregoing objects and other objects of the invention are accomplished by a laser surgical instrument is comprising a laser element mounted in a first hollow tubular member with a tapered open tip for insertion into a surgical site and having an opening at one end for connection by a hollow tubing to a source of a purge gas for keeping the laser focusing lens free from smoke. A second tubular member is removably fitted on the first tubular member and extends substantially to the first tubular element tapered end. The second tubular has a side opening for connection to a source of vacuum. A sleeve is slidably mounted on the second tubular member and is movable between a retracted position exposing the tip of the first tubular member and an extended position extending into the surgical site to provide a hood for withdrawal of smoke. The movement of the sleeve between retracted and extended positions provides for selected application of vacuum to the surgical site.